Assessment and Clinical Judgement | Part A and B

Running head: NURSING
Assessment and Clinical Judgement
Name of the Student
Name of the University
Author Note

1NURSING
Part A
Error Definition Example from video
Anchoring The tendency to lock onto salient
features in the patient’s presentation too
early in the clinical reasoning process,
and failing to adjust this initial
impression in the light of later
information. Compounded by
confirmation bias (see below).
Initial impression of presence
of generalized symptoms of
pain and ache and no instance
of vomiting since the last day.
Assessment of few vital signs
and discharging the patient
after they return to normal
level.
Ascertainment
bias
When a nurse’s thinking is shaped by
prior assumptions and preconceptions,
for example ageism, stigmatism and
stereotyping.
The hospital authorities had
the perception that
Naomi presented signs and
symptoms of stomach pain and
nausea, since she had been and
occasional marijuana
smoker. Repeated reference to
the alcohol and drug
counselling service.
Confirmation
bias
The tendency to look for confirming
evidence to support a nursing diagnosis
rather than look for disconfirming
evidence to refute it, despite the later
Despite evidences that
Naomi had not been an addict,
frequent enquiries were
conducted to establish

2NURSING
often being more persuasive and
definitive.
correlation between her
symptoms and marijuana
withdrawal.
Diagnostic
momentum
Once labels are attached to patients they
tend to become stickier and stickier.
What started as a possibility gathers
increasing momentum until it become
definite and other possibilities are
excluded.
Stereotyping Naomi as a drug
addict, resulted in negligence
on the part of the healthcare
professionals to overlook her
presenting complaints, which
prevent the delivery of
appropriate care services,
Fundamental
attribution error
The tendency to be judgemental and
blame patients for their illnesses
(dispositional causes) rather than
examine the circumstances (situational
factors) that may be responsible.
Psychiatric patients, those from minority
or marginalised groups are at risk of
this error.
Persistence racial
discrimination against
Naomi by the hospital staff
and their tendency to explain
her symptoms as a direct
consequence of
marijuana consumption.
Overconfidenc
e bias
A tendency to believe we know more
than we do. Overconfidence reflects a
tendency to act on incomplete
information, intuition or hunches. Too
much faith is placed on opinion instead
Incomplete assessment of all
necessary vital signs, and
immediate discharge of
patient, after some of them
gave normal readings, despite

3NURSING
of carefully collected cues. This error
may be augmented by anchoring.
the fact that four vital signs
characterised the yellow zone.
Premature
closure
The tendency to apply premature closure
to the decision-making process,
accepting a diagnosis before it has been
fully verified. This error accounts for a
high proportion of missed nursing
diagnosis.
Rapid patient discharge
Psych-out error Psychiatric patients are particularly
vulnerable to clinical reasoning errors,
especially fundamental attribution
errors. Co-morbid conditions may be
overlooked or minimalised. A variant of
this error occurs when medical
conditions (such as hypoxia, delirium,
electrolyte imbalance, head injuries etc.)
are misdiagnosed as psychiatric
conditions.
The risk of sepsis among
pregnant females had been
overlooked and not
appropriately assessed, in
addition to poor
communication about Naomi
being a high-risk maternity
patient.
Unpacking
principle
Failure to collect all the relevant cues in
establishing a differential diagnosis may
result in significant possibilities being
missed. The more specific a description
of an illness that is received, the more
No pain assessment and
inappropriate measurement of
vital signs.

4NURSING
likely the event is judged to exist. If an
inadequate patient history is taken
unspecified possibilities may be
discounted.

5NURSING
Part 2
An accident patient, male, aged 54 years, who had been provided care in the Intensive
Care Unit was transferred to the general medical staff when it was decided that he no longer
required one-to-one care or closed observation. The incident involving a clinical judgment
error involved incorrect positioning and large blood pressure cuff. This incident can be
attributed to the context of the clinical environment, since there were several patients who
had to be monitored at regular intervals, which resulted in a workload, thus preventing
appropriate vital signs assessment.
At the time of measuring blood pressure, the patient was sleeping on his side, which
provided an inaccurate low reading. Measurement of the blood pressure was done by using a
cuff that was of an incorrect size. The extreme workload prevented adjusting the blood
pressure cuff appropriately, such that it fitted the arm of the patient. The cuff placed on the
patient's arm was too big, thus the blood pressure measurement was falsely reduced.
Therefore, similar to the aforementioned incident, low blood pressure reading obtained,
resulted in a misdiagnosis of hypotension.
The aforementioned two clinical judgment errors could have been avoided, had the
patient been ask to maintain a high-fowler or semi-fowler position, for not less than five
minutes, prior to measuring the blood pressure. This would have ensured that the blood
pressure cuff was at level near the heart. In addition, it was imperative to appropriately size
the blood pressure cuff, in order to fit the arm of the patient, such that the bladder
encompassed roughly 80% of the circumference of the arm. In future practice, efforts will be
taken to prevent any errors during vital signs measurement, owing to the fact that a slight
variation in the vital sign can provide incorrect information about the patient's health status,
thus worsening patient outcomes.